Mixed Reality and Augmented Reality in Shoulder Arthroplasty: A Literature Review

Abstract

Background: Reversed shoulder arthroplasty is considered a treatment choice for arthritis and irreparable/massive cuff-tears. The accurate placement of the glenoid baseplate, particularly the positioning of the central peg or screw as well as the inclination and version has been considered critical in reducing implant related intra- and postoperative complications. While the implant positioning and position of the screws can be planned preoperatively on three-dimensional imaging modalities, the lack of intraoperative access to the information and the visual monitoring of variations achieved in the surgery can lead to low reproducibility. The ongoing innovation in the reality technologies aim to improve the accuracy and precision in implantation of the components with a hypothesis that it improves the implant survivorship and the outcomes. Aims: This review aims to provide an overview on the currently available mixed and augmented reality technologies in shoulder arthroplasty, their differences, and potential future applications in shoulder arthroplasty. Methods: For this literature review, all relevant published reports were found via searches in Medline (PubMed) database using the following medical subject headings (MeSH) terms: “virtual reality” or “augmented reality” or “mixed reality” with “orthopedics” or “orthopedic surgery.” Additional searches were carried out using the same key words in other databases including Ovid, Science Direct, SpringerLink, and Google Scholar, finding further relevant titles. Results: The systematic search query resulted in 61 articles of which 8 articles met the inclusion and exclusion criteria. Two out of 3 clinical studies were published by the same group of authors, whereas 1 study elaborated a technical note of the application of navigated augmented reality technology in reversed shoulder arthroplasty. Among the remaining 5 (non-clinical) studies, 3 studies were feasibility studies while 1 study used the navigated augmented reality technology over 12 cadaveric scapulae. The remaining 1 study was a proof-of-concept study over saw bone models based on the CT scans of one single patient. Conclusions: This study gives the clarity between mixed and augmented reality that have been interchangeably used in the literature. We believe that the inclusion of mixed reality and augmented reality technology can enhance the precision during surgery, potentially reducing implant related complications and revision rates. However, further studies evaluating the radiographic parameters on implant-positioning, surgical, functional, and patient reported outcomes of this technology are called for its global acceptance.

Three-dimensional planning, navigation, patient-specific instrumentation and mixed reality in shoulder arthroplasty: a digital orthopedic renaissance

“…MR often employs transparent or semi-transparent headsets to blend digital content with the real environment ( 58 ). Currently, applications of VR in surgery are primarily focused on preoperative planning, patient education, and practical training for surgical techniques to enhance residents' skills ( 59 ). Notably, both AR and MR are being used during the operative procedure itself ( 59 ).…”